Evidence of grave vitamin A deficiency among lactating women in the semi-arid rural area of Makhaza in Zimbabwe. A population-based study

Projecting the Contribution of Provitamin A Maize Biofortification and Other Nutrition Interventions to the Nutritional Adequacy and Cost of Diets in Rural Zimbabwe

BACKGROUND

Evidence of the effectiveness of biofortified maize with higher provitamin A (PVA) to address vitamin A deficiency in rural Africa remains scant.

OBJECTIVES

This study projects the impact of adopting PVA maize for a diversity of households in an area typical of rural Zimbabwe and models the cost and composition of diets adequate in vitamin A.

METHODS

Household-level weighed food records were generated from 30 rural households during a week in April and November 2021. Weekly household intakes were calculated, as well as indicative costs of diets using data from market surveys. The impact of PVA maize adoption was modeled assuming all maize products contained observed vitamin A concentrations. The composition and cost of the least expensive indicative diets adequate in vitamin A were calculated using linear programming.

RESULTS

Very few households would reach adequate intake of vitamin A with the consumption of PVA maize. However, from a current situation of 33%, 50%-70% of households were projected to reach ≤50% of their requirements (the target of PVA), even with the modest vitamin A concentrations achieved on-farm (mean of 28.3 μg RAE per 100 g). This proportion would increase if higher concentrations recorded on-station were achieved. The estimated daily costs of current diets (mean ± standard deviation) were USD 1.43 ± 0.59 in the wet season and USD 0.96 ± 0.40 in the dry season. By comparison, optimization models suggest that diets adequate in vitamin A could be achieved at daily costs of USD 0.97 and USD 0.79 in the wet and dry seasons, respectively.

CONCLUSIONS

The adoption of PVA maize would bring a substantial improvement in vitamin A intake in rural Zimbabwe but should be combined with other interventions (e.g., diet diversification) to fully address vitamin A deficiency.

Fruit and vegetable consumption and serum vitamin A in lactating women: A cross-sectional survey in urban China

During the lactation period, healthy eating behavior is essential to maternal and child health. However, Chinese lactating women may have some traditional food restrictions. Our aims were to evaluate the fruit and vegetable consumption of Chinese lactating women and to examine the associations between fruit and vegetable consumption and serum vitamin A concentrations. A total of 885 participants were included. Dietary intakes were assessed during the same time frame as blood collection via a one-time 24-h dietary recall (24HDR) and a semiquantitative food frequency questionnaire (SFFQ), respectively. Serum vitamin A concentrations were assessed with high-performance liquid chromatography. Based on 24HDR, 64.7% and 85.5% of lactating women did not consume the appropriate amount of fruits and vegetables, respectively. New mothers who adopt zuo yuezi behavior during the first month were negatively associated with fruit consumption. The median (25th to 75th) dietary vitamin A intake was 349.5 (202.5-591.4) μg RAE/day. Vegetable contributed 24.9% and fruit 4.8% of the dietary vitamin A intake. The median (25th to 75th) serum vitamin A concentration was 1.92 (1.61-2.30) μmol/L. 24HDR assessments of total fruit and vegetable consumption, and fruit consumption were positively associated with higher serum vitamin A concentrations, respectively (β = 0.200, 95%CI = 0.077, 0.323, p = .001; β = 0.241, 95%CI = 0.008, 0.474, p = .044). These positive associations were replicated in the SFFQ assessments (β = 0.102, 95%CI = 0.016, 0.188, p = .020; β = 0.215, 95%CI = 0.088, 0.341, p = .001). Chinese lactating women had inappropriate fruit and vegetable consumption. Fruit and vegetable consumption was associated with serum vitamin A concentrations.

Systematic Review and Meta-Analysis of the Relative Dose-Response Tests to Assess Vitamin A Status

Vitamin A (VA) is an essential nutrient often lacking in the diets of people in developing countries. Accurate biomarkers of VA status are vital to inform public health policy and monitor interventions. The relative dose-response (RDR) and modified-RDR (MRDR) tests are semi-quantitative screening tests for VA deficiency that have been used in Demographic and Health Surveys and VA intervention studies. A systematic review and meta-analysis of sensitivity and specificity were conducted to summarize the physiological evidence to support the RDR tests as methods to assess VA status and investigate the impact of different pathological and physiological states on the tests. A total of 190 studies were screened for inclusion, with 21 studies comparing the RDR tests with the gold-standard biomarker, liver VA concentration (68% and 80% sensitivity and 85% and 69% specificity for the RDR and MRDR, respectively). Nearly all studies with VA interventions in VA-deficient populations demonstrated a response of the tests to VA intake that would be expected to improve VA status. The impacts of chronic liver disease, protein malnutrition, age, pregnancy and lactation, infection and inflammation, and various other conditions were examined in 51 studies. The RDR and MRDR tests were reported to have been used in 39 observational studies, and the MRDR has been used in at least 6 national micronutrient surveys. The RDR and MRDR are sensitive tests for determining population VA status and assessing VA interventions. Although they are robust to most physiological and pathological states, caution may be warranted when using the tests in neonates, individuals with chronic liver disease, and those with protein or iron malnutrition. Research on further improvements to the tests to increase accessibility, such as sampling breast milk instead of blood or using intramuscular doses in subjects with malabsorption, will allow wider adoption. This review was registered with PROSPERO as CRD42019124180.

Adequate vitamin A rich food consumption and associated factors among lactating mothers visiting child immunization and post-natal clinic at health institutions in Gondar Town, Northwest Ethiopia

BACKGROUND

Vitamin A deficiency is highly prevalent in low-income countries and is a major public health problem worldwide. Lactating mothers are the most vulnerable population group to vitamin A deficiency. Despite this, there is limited study on vitamin A-rich food consumption by lactating mothers in Ethiopia. Therefore, this study aimed to assess adequate vitamin A rich food consumption and associated factors among lactating mothers visiting child immunization and postnatal care centers in health institutions of Gondar Town.

METHODS

An Institution-based cross-sectional study design was employed at a health institution in Gondar Town from February to March 2019, and included 631 study participants. Simple random sampling followed by a systematic sampling technique was used to select participants. The data were collected using the Helen Keller International Food Frequency Questionnaire, entered using Epi-Info 7 statistical software and exported to STATA version 14 for analysis. A multivariable logistic regression analysis was used to identify factors associated with the outcome variable and variables with p-value <0.05 were considered as statistically significant.

RESULT

A total of 624 lactating mothers participated in the study giving a response rate of 98.89%. The study shows adequate consumption of vitamin A-rich food was 38.94% (95% CI: 35%- 43%). Predictors such as attending college diploma and above (AOR = 2.26, 95% CI; 1.02-4.99), having household family size ≤ 3 (AOR = 4.04, 95% CI; 1.60-10.17), being in higher economic class (AOR = 1.93, 95% CI; 1.18-3.14), having dietary diversity score of ≥ 5 (AOR = 1.59, 95% CI; 1.09-2.32) and meal frequency of ≥ 4 (AOR = 1.64, 95% CI; 1.09-2.32) were statistically significant.

CONCLUSION AND RECOMMENDATION

The majority of respondents had inadequate consumption of foods rich in vitamin A. Educational status, family size, wealth index, dietary diversity, and meal frequency were found to be factors that affect adequate consumption of vitamin A-rich foods. Encouraging and educating lactating mothers to consume foods rich in vitamin A is crucial.

Prevalence of infant and maternal anemia during the lactation period in Japan

BACKGROUND

The perinatal period is associated with a high risk of infant anemia. The aim of the present study was to determine the prevalence of infant and maternal anemia during the late lactation period and the risk factors for anemia in Japan.

METHODS

This retrospective cohort study was based on data from health checkups of healthy infants at 6-7 and 9-10 months of age and their mothers who visited Akitsu Children's Clinic between September 2013 and August 2015. Complete blood count data from infant blood samples obtained at 6-7 months and 9-10 months and from maternal blood samples obtained at 6-7 months, information on feeding methods, and other related parameters were analyzed.

RESULTS

Data from 388 mother-infant pairs were analyzed. The prevalence of infant anemia was 21.1% at 6-7 months and 29.1% at 9-10 months. The prevalence of anemia in exclusively breast-fed infants was 28.4% at 6-7 months and 40.0% at 9-10 months. The risk factors for infant anemia at 9-10 months were exclusive breast-feeding, lower gestational age at birth, male sex, and high weight gain. The prevalence of maternal anemia was 10.5%. There was no correlation between infant and maternal hemoglobin in exclusively breast-fed infants.

CONCLUSIONS

Japanese infants who were breast-fed exclusively had a high prevalence of anemia. A nationwide strategy to prevent anemia is required to prevent infant anemia, even in a nutrition-rich country such as Japan.

An evidence-based systematic review of vitamin A by the natural standard research collaboration

An evidence-based systematic review of vitamin A by the Natural Standard Research Collaboration consolidates the safety and efficacy data available in the scientific literature using a validated and reproducible grading rationale. This paper includes written and statistical analysis of clinical trials, plus a compilation of expert opinion, folkloric precedent, history, pharmacology, kinetics/dynamics, interactions, adverse effects, toxicology, and dosing.

High prevalence of vitamin A deficiency is detected by the modified relative dose-response test in six-month-old Senegalese breast-fed infants

To alleviate vitamin A (VA) deficiency (VAD) in Senegal, understanding the relationship between VA status of lactating women and their 6-mo-old infants is important. This study measured 6-mo-old infants' VA intake from human milk and assessed the VA status of mothers and infants. A comprehensive study was undertaken in 34 mother-infant pairs. Nonpregnant lactating women and their infants were included. None of the infants had received a VA supplement. Mothers were grouped as supplemented with 2 doses of 200,000 iu (60,000 μg; 210 μmol) retinol as retinyl palmitate (n = 13) or nonsupplemented (n = 19) after delivery. Breast milk intake was measured by the deuterium dilution technique. Plasma and breast milk retinol concentrations were measured by HPLC. Infants' VA liver stores were assessed by the modified relative dose-response (MRDR) test. Plasma retinol detected 15% VAD among infants and the MRDR test (≥0.06) indicated 73.5% with low VA liver stores. Infants' milk VA intakes were close to estimated requirements (375 μg/d). No correlation was found between infants' plasma retinol and MRDR value. Infants' MRDR value was lower in the group from supplemented mothers (0.055 ± 0.017 vs. 0.073 ± 0.017; P = 0.009), but no difference was observed between plasma retinol concentrations of both groups of mothers; 8.8% of mothers were VA deficient based on plasma retinol (≤0.7 μmol/L). Low VA liver stores were prevalent among Senegalese infants at the beginning of the complementary feeding period. Postpartum VA-supplemented mothers significantly enhanced their infants' VA liver stores.

Vitamin A fortification of wheat flour: considerations and current recommendations

BACKGROUND

Vitamin A deficiency is a major public health nutrition problem, affecting an estimated 190 million preschool-aged children and 19 million pregnant and lactating women globally, and 83 million adolescents in Southeast Asia alone. Its consequences (disorders) include xerophthalmia (the leading cause of early childhood blindness), increased severity of infection, anemia, and death. Because vitamin A deficiency is largely due to chronic dietary insufficiency of preformed vitamin A and proactive carotenoids, food fortification can offer an effective approach to prevention.

OBJECTIVE

To provide guidance on fortifying wheat and maize flour milled in industrial rollers for national fortification programs in countries where vitamin A deficiency is considered a public health problem.

METHODS

Critical review of the literature on the dietary gap in vitamin A intake and levels of wheat flour intake among risk groups as a basis for determining vitamin A fortificant levels. Additional review of efficacy evidence, safety and cost considerations, and country experiences related to wheat-flour fortification with vitamin A.

RESULTS

Mill-rolled wheat flour is a technically fortifiable, centrally processed food vehicle that, where routinely and adequately consumed by target groups, should be considered a candidate for fortification. Vitamin A can be stable in flour under typical, ambient conditions, with processing losses estimated at approximately 30%, depending on source and premix conditions.

CONCLUSIONS

Factors to guide a decision to fortify flour with vitamin A include the extent of deficiency, availability of other food vehicle options, the centrality of milling, market reach and population intake distributions of the flour products, the dietary vitamin A intake required, and associated costs. Large gaps persist in knowledge of these factors, which are needed to enable evidence-based fortification in most countries, leaving most decisions to fortify guided by assumptions. Where flour can and should be fortified, guidelines are given for providing nearly 25% of the Recommended Dietary Allowance for vitamin A to vulnerable groups consuming varying ranges of flour products. The costs will vary according to the level of fortification.

Effect of postpartum maternal or neonatal vitamin A supplementation on infant mortality among infants born to HIV-negative mothers in Zimbabwe

BACKGROUND

Young infants are at risk of vitamin A deficiency. Supplementation of breastfeeding mothers improves the vitamin A status of their infants, but there are no data regarding its effect on infant mortality, and data on the effect of directly supplementing infants during the first few weeks of life are conflicting.

OBJECTIVE

The objective was to measure the effect on infant mortality of supplementing neonates and their HIV-negative mothers with single, large doses of vitamin A during the immediate postpartum period.

DESIGN

A randomized, placebo-controlled, 2-by-2 factorial design trial was conducted in 14,110 mothers and their infants; 9208 of the mothers were HIV-negative at delivery, remained such during the postpartum year, and were retained in the current analysis. The infants were randomly assigned within 96 h of delivery to 1 of 4 treatment groups: mothers and infants received vitamin A (Aa), mothers received vitamin A and infants received placebo (Ap), mothers received placebo and infants received vitamin A (Pa), and both mothers and infants received placebo (Pp). The vitamin A dose in the mothers was 400,000 IU and in the infants was 50,000 IU. The mother-infant pairs were followed to 12 mo.

RESULTS

Hazard ratios (95% CI) for 12 mo mortality among infants in the maternal-supplemented and infant-supplemented groups were 1.17 (0.87, 1.58) and 1.08 (0.80, 1.46), respectively. Hazard ratios (95% CI) for the Aa, Ap, and Pa groups compared with the Pp group were 1.28 (0.83, 1.98), 1.27 (0.82, 1.97), and 1.18 (0.76, 1.83), respectively. These data indicate no overall effect. Serum retinol concentrations among a subsample of women were similar to reference norms.

CONCLUSION

Postpartum maternal or neonatal vitamin A supplementation may not reduce infant mortality in infants of HIV-negative women with an apparently adequate vitamin A status.

Consumption of Vitamin A by Breastfeeding Children in Rural Kenya

Vitamin A deficiency remains a significant health risk in developing countries, affecting infants and children in particular. To counter child malnutrition, mothers are encouraged to breastfeed to ensure that their children receive adequate macro- and micronutrients, including vitamin A. However, this assumes that the mother has sufficient vitamin A intake to provide enough vitamin A to her child. This study investigates maternal and infant intakes of locally available foods of high vitamin A content in a rural agricultural community in Kenya. The study aims to establish the community risk for vitamin A deficiency and to assess whether breast milk is adequate to maintain and build retinol reserves of the breastfed infant. The study assesses 62 mother-child pairs and employs several methods to support its objectives, including the Helen Keller International food-frequency survey, maternal and infant anthropometric measurements, and maternal breast-milk and blood samples to determine breast-milk and serum retinol levels. We found that mothers with marginal (< 0.700 μmol/l) serum retinol and breast-milk deficient (< 1.05 μmol/l) in retinol accounted for 45.2% and 77.4%, of our sample, respectively. A significant (p < 0.05) proportion (40.3%) of mothers had breast milk deficient in retinol and marginal levels of serum retinol. The risk of vitamin A deficiency in breastfed infants older than six months was high, because 89.5% of them did not consume foods high in vitamin A content three times weekly. The primary source of vitamin A for infants younger than six months was breast-milk deficient in retinol vitamin A. This study suggests that in this rural community, breastfed infants may not receive appropriate foods with high vitamin A content and that although exclusive breastfeeding is advocated, most breast milk is deficient in retinol, further heightening the risk of vitamin A deficiency.

Plasma retinol concentration according to pubertal maturation in school children and adolescents of Medellín, Colombia

AIM

To describe plasma retinol values according to age, gender and pubertal maturation.

TYPE OF STUDY

Comparative, transverse and descriptive.

PLACE

Medellín, Colombia.

SUBJECTS AND METHODS

Plasma retinol values were determined in 588 boys and 531 girls aged between 6 and 18 y. For this, we used spectrophotometry by UV oxidation of retinol, results below 0.87 mmol/l were confirmed by high-performance liquid chromatography.

RESULTS

Mean retinol plasma concentrations were slightly higher in girls under 10 y. However, above this age, values are generally higher in boys. Plasma retinol concentrations increased with pubertal maturation in both boys and girls in a statistically significant manner. The highest values were observed in girls with mammary development grades 3 and 4 (P<0.05) and in boys with external genitalia development grades 1 and 2 (P<0.05). Vitamin A deficiency based on plasma retinol concentration (<0.70 mmol/l), was observed in 3.6% of all individuals regardless of gender.

CONCLUSIONS

Plasma retinol concentration is correlated to pubertal maturation in both boys and girls. Vitamin A deficiency in school children and adolescents of Medellín is not a major health problem.